Women's Swimming & Diving Recruiting Questionnaire

Please complete the following form with all available information. Hit the SUBMIT button at the bottom to electronically submit. If submitting a questionnaire by mail, please type or print all answers and mail to address listed at the bottom.

Indicates a Required Field

Last Name:

First Name:

Middle Initial:

Date of Birth:

Email Address:

Home Phone:

Cell phone number:

Street Address:

City:

State:

Zip:

50 Free:

100 Free:

200 Free:

500 Free:

1000 Free:

1650 Free:

100 Back:

200 Back:

100 Breast:

200 Breast:

100 Fly:

200 Fly:

200 I.M.:

400 I.M.:

1 Meter List:

1 Meter Score:

3 Meter List:

3 Meter Score:

Other sports participated in & number of years:

Athletic Honors Received:

Name of your current head coach:

Coach's Email Address:

Coach's Phone Number:

Name of your high school:

High school street address:

High school city:

High school state:

High school zip:

Cumulative Grade Point:

Class rank:

ACT/SAT Score (if available):

Graduation Date and Year:

Academic Interest Area(s):

Mother's Name:

Mother's Street Address:

Mother's City:

Mother's State:

Mother's Zip:

Mother's Phone Number:

Father's Name:

Father's Street Address:

Father's City:

Father's State:

Father's Zip:

Father's Phone Number:

Marital Status of Your Parents:

Married

Separated

Divorced

Deceased

Brothers & Sisters (Names & Ages):

Name / Signature:

Date:

Verification Code:

If you are not sure what the words are, enter your best guess.

You may choose to submit this questionnaire electronically: or by mail, to: